Hull, Breana (2018). The relationship between sex trafficking and immune function: The role of exposure to abuse.
Background: Sex trafficking and abuse are each uniquely associated with numerous poor mental and physical health outcomes. Individuals who sell sex often have a history of abuse by a parent during childhood prior to exploitation in sex trafficking (Kaestle, 2012; TVPA, 2000). Research supports that many mental disorders and other chronic physical conditions are predicted by toxic stress, through the over-activation of stress-mediating systems causing alterations in immune function (Shonkoff et al., 2012). Although research is building on the effects of abuse during childhood and adolescence on physiological stress, to date, sex trafficking victimization has not been examined as a predictor of physiological stress, including immune function. Purpose: The specific aims for this study were to examine (1) the extent to which sex trafficking before age 18 predicts immune function (high-sensitivity C-reactive protein [CRP] and reactivation of the Epstein-Barr virus [EBV]) in young adulthood and (2) to examine the extent to which exposure to abuse during childhood and adolescence moderates the relationship between sex trafficking and immune function. Theoretical Framework: This study was guided by the ecobiodevelopmetal (EBD) framework, which conceptualizes health as a result of the interaction between biological and environmental factors on health and development. This framework highlights the importance of critical developmental periods, such as childhood and adolescence linking adverse childhood experiences and toxic stress to consequences in development and physiological maladaptation. Attachment Theory also guided this study, placing abuse by a parent or caregiver in the context of the associated insecure attachment patterns. Methods: A secondary analysis was conducted using all four waves (1994-2008) of The National Longitudinal Study of Adolescent to Adult Health (Add Health) - a nationally representative, school-based study. Sex trafficking was measured using self-report items from Waves I and II, in which participants were under age 18 and reported whether they had sold sex for money or drugs. Immune function was measured via high sensitivity C-reactive protein and Epstein-Barr Virus IgG antibodies; both were collected through capillary finger sticks at Wave IV. Exposure to abuse was measured using items from Waves IV, during which youth reported exposure to emotional abuse, physical abuse, and sexual abuse retrospectively prior to age 18. Multiple linear regression with moderating analyses using SAS version 9.4 were performed to address the aims of this study. Results: In bivariate analyses, sex trafficking before age 18 significantly predicted hs-CRP in young adulthood for the full sample (parameter estimate 0.23, p<.05), and for males (parameter estimate 0.36, p<.01), but not for females. The bivariate relationship between sex trafficking and EBV was not significant. The moderating effect of adulthood sex exchange and sexual abuse before age 18 was significantly associated with young adulthood hs-CRP (parameter estimate 0.87, p<.05) and EBV (parameter estimate 0.80, p<.05) for females only. Discussion: Future longitudinal research should explore the relationships between sex trafficking and immune function across the life course. Sex trafficking remains a social justice and public health concern.
Sex trafficking, prostitution, C-reactive protein, Epstein-Barr virus, stress, life course, adolescence, young adulthood, maltreatment, abuse, biomarkers, Add Health, adversity, inflammation, immunity, CRP, EBV, cell-mediated immunity, immune function
The Ohio State University